Feldman: The heartbreaking withdrawal of opioid-dependent babies

This is a kit full of items, including these vials of Naloxone HCl that would be injected in patients who have suffered opioid overdoses. It is seen on an Indianapolis EMS ambulance stationed at Eskenazi Hospital, Tuesday, January 10, 2017.(Photo: Kelly Wilkinson/IndyStar)Buy Photo

We are in the midst of a terrible epidemic. Its cause is not an infectious disease but rather the abuse of opioids. Over 2 million people in the United States abuse or are dependent on opioids. There has been a quadrupling of prescription opioid abuse since 1999.

Increasingly, opioid prescription medications are misused, abused and diverted for sale. Opioid pain medications have become some of the easiest drugs to obtain on the streets and now exceed other illicit drug use. Indiana ranks ninth highest in opioid prescriptions per capita; one in five Indiana teenagers admits to abusing prescription drugs.

The epidemic was fueled by skyrocketing numbers of opioid prescriptions. Some corrupt physicians illegally prescribe to addicts much like drug dealers, but most of the problem was caused by good physicians caught in expectations and even requirements placed upon them to more liberally prescribe to treat pain. That eventually led to loose prescribing and refilling practices.

Concurrently, heroin use has dramatically increased. No age, income or gender group is immune. Recent tightening of opioid prescribing practices has made opioid medications on the street more expensive and difficult to obtain. Heroin has become the cheaper and more lethal alternative.

With greater use has come an explosion of opioid overdose deaths. Prescription opioid overdoses have increased 400 percent over the last 15 years and heroin overdose deaths have increased 300 percent since 2010. Indiana ranks 15th among the states. Seventy-eight people die every day in the U.S. from an opioid overdose.

There is actually an infectious-disease component to the opioid epidemic involving HIV and hepatitis B and C among IV-drug users. It is estimated that 50 to 80% of people who inject drugs will contract one of these viruses within five years. The problems that occurred in Scott County and other rural Indiana counties are well known.

But the opioid crisis doesn’t end here. One of its most tragic aspects affects the youngest, most vulnerable and innocent. Babies of addicted pregnant women are regularly born opioid dependent and commonly experience Neonatal Abstinence Syndrome. Infants with NAS may withdraw for weeks or even months. Longer-acting opioids like methadone, commonly used to treat addiction, cause the longest withdrawals. Most babies are weaned slowly with methadone or morphine during extended hospitalizations.

These newborns can experience heartbreakingly severe and intense withdrawal, including inconsolable crying, hyperirritability, spasticity, seizures, tremors, fever, difficulty eating, excessive weight loss, dehydration, vomiting, diarrhea and difficulty breathing. These babies typically are hospitalized in the neonatal intensive care unit and can run up bills of $150,000 to over $220,000.

Nationally, NAS increased 500 percent between 2000 and 2012. At Franciscan Health Indianapolis, at any given time, there are two to four NAS babies in NICU; at IU Health Methodist, frequently half the babies in NICU are in opioid withdrawal. One state-sponsored study suggests that 20 percent of babies born in Indiana test positive for opioids. The tragedy for these NAS babies continues into childhood with increased risk for emotional, behavioral, developmental and visual problems.

The federal government has issued new regulations tightening opioid prescribing and the Indiana legislature continues to enact legislation requiring more responsible prescribing as well as funding for pilot programs for better treatment of addicted pregnant women and their NAS babies.

Ultimately, increased access to and funding for addiction treatment is critical. However, recent federal budget and Medicaid funding-cut proposals would place enhanced treatment measures in jeopardy.

Opioid prescriptive restrictions and regulations will not solve the opioid crisis alone. It must be coupled with the most imposing and difficult task: Removing heroin from our streets.

Feldman is an Indianapolis family physician and former Indiana health commissioner. Email him at richarddfeldman@gmail.com.